Get the free Delaware Medical Assistance Provider Enrollment Application

This document is an enrollment application for individual healthcare providers seeking to participate in the Delaware Medical Assistance Program, requiring various supporting documents and information.

How to fill out delaware medical assistance provider

How to fill out Delaware Medical Assistance Provider Enrollment Application

1. Obtain the Delaware Medical Assistance Provider Enrollment Application form from the Delaware Division of Medicaid & Medical Assistance website.
2. Read the instructions carefully to understand the necessary documentation and requirements.
3. Fill out the provider's information section accurately, including your name, business address, and contact details.
4. Complete the sections related to the type of services you will provide, ensuring you select the appropriate categories.
5. Provide any required additional documentation as specified in the application instructions.
6. Review the application for completeness and accuracy before submission.
7. Sign and date the application where indicated.
8. Submit the completed application along with any required documentation to the specified address or online submission portal.

Who needs Delaware Medical Assistance Provider Enrollment Application?

1. Healthcare providers who wish to participate in Delaware's Medical Assistance program.
2. Individuals or organizations that provide medical services, including doctors, hospitals, nursing facilities, and home health agencies.
3. Providers who need to bill Delaware Medicaid for services rendered to eligible beneficiaries.

People Also Ask about

How long does Medicaid provider enrollment take?

Once your agreement is signed and returned to the network, you are given an effective date and provider number so that you can begin billing the plan and receiving “In-Network” reimbursement for your claims. Expect networks to take 30 – 45 days for this process (after credentialing is complete).

What is the phone number for Delaware Medicaid provider enrollment?

State of Delaware - Search and Services/Information Enter your assigned tracking number and Tax ID to verify the current status of your enrollment application. For further questions, please contact Provider Services at (800) 999-3371 opt. 0 then 4. * Indicates a required field.

What is a provider enrollment form?

Provider Enrollment (or Payor Enrollment) refers to the process of applying to health insurance networks for inclusion in their provider panels. For Commercial Insurance networks, this process involves two steps, 1) Credentialing and 2) Contracting.

How long does Medicaid approval take in SC?

Generally, it takes up to 45 days for Healthy Connections to determine eligibility, though determination times can increase for certain applicant categories.

How long does it take to process Medicare provider enrollment?

Step 1 Processing Time (Varies by Submission Method): Paper: Approximately 65 days. Web: Approximately 30 days. A certified provider's CMS-855 application is required to go through a multistep review process. Medicare Administrative Contractors (MACs) are responsible for the initial review of the application.

How long does a Medicaid provider application take?

Expect a Medicare application to be completed in 60-90 days if there are no unusual issues.

How long does Medicaid take to apply?

States are required by federal law to approve or deny Medicaid applications within 45 days, or 90 days for applications that require a disability determination.

For pdfFiller’s FAQs

What is Delaware Medical Assistance Provider Enrollment Application?

The Delaware Medical Assistance Provider Enrollment Application is a form that healthcare providers must complete to enroll in the Delaware Medical Assistance Program, which allows them to provide services to Medicaid beneficiaries.

Who is required to file Delaware Medical Assistance Provider Enrollment Application?

Healthcare providers who wish to offer services covered by the Delaware Medical Assistance Program must file the application, including physicians, specialists, and facilities.

How to fill out Delaware Medical Assistance Provider Enrollment Application?

To fill out the application, providers must gather necessary information such as their credentials, services offered, and any prior enrollment details, then complete the form ensuring all sections are accurately filled before submission.

What is the purpose of Delaware Medical Assistance Provider Enrollment Application?

The purpose of the application is to formally enroll healthcare providers in the Delaware Medical Assistance Program so that they can receive reimbursement for services rendered to Medicaid beneficiaries.

What information must be reported on Delaware Medical Assistance Provider Enrollment Application?

Providers must report personal and professional information, including their National Provider Identifier (NPI), practice location, services provided, and any relevant background checks or credentials.